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Meet time, education requirements to guarantee ACP coding success

03/04/2019

Don’t sweat the details of advance care planning (ACP) codes 99497 and 99498. You’ll find significant leeway in how you choose to approach and report ACP services given CMS’ open-ended coding requirements, which should push the already strong growth of the codes to new heights.

Office E/M codes not always used in the office – and not always denied when they’re not

03/04/2019

by: Roy Edroso

Office E/M codes — 99201-99205 for new patients, 99211-99215 for established patients — are usually filed with the office place-of-service code (POS) 11, but they’re also filed from other sites and, to a surprising extent, accepted by Medicare contractors when they are.

Few PTs will have to do MIPS in 2019 — but look for opportunities to opt in

02/25/2019

by: Roy Edroso

Only a fraction of physical therapy providers will be required to do MIPS in 2019. But some will have the option to get in and score bonuses, and a time cushion gives them a chance to see whether it’s worth doing.

Medicare Advantage model promotes ‘high-value providers’ for cost-sharing benefits

02/25/2019

by: Richard Scott

Keep an eye on the early results of the value-based insurance design (VBID) that CMS is expanding nationally in 2020: Only “high-value providers” will be eligible for the care enticements, such as reduced co-pays and getting paid for telehealth services, that are expected to be on offer to patients.

Keep checklist and be ready for violent threats against your practice

02/25/2019

by: Roy Edroso

A spate of recent bomb scares in medical facilities increases the need for an action plan that neither overestimates nor underestimates the threat and keeps staff and patients safe.

Question about 2019 CPT codes for interprofessional consultations

02/25/2019

by: Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC

Question: What 2019 CPT updates were made to E/M codes for interprofessional telephone and internet consultations?

Value-based round-up: Medicare Advantage plans offer differences in design

02/25/2019

by: Richard Scott

Primary care practices and appropriate specialties may welcome additional coverage options and less cost-sharing among their patients who are tethered to the Medicare Advantage Value-Based Insurance Design (MA-VBID) model.

You can now add heart-failure patients to your cardiac rehabilitation program

02/18/2019

by: Richard Scott

Practices that engage in heart-health exercise programs can now welcome a new subset of patients to intensive cardiac rehabilitation (ICR) encounters, CMS announced Feb. 6 in MLN Matters 11117.

New CMS/ONC rules would encourage interoperability, make sharing discharge data mandatory

02/18/2019

by: Roy Edroso

CMS and the Office of the National Coordinator for Health Information Technology (ONC) have introduced proposed rules that would streamline current EHR infrastructure requirements and — of special interest to providers who perform chronic care management (CCM) and transitional care management (TCM) — require hospitals to make admission, discharge and transfer information available to other providers in a timely manner.

Prior authorization still a problem; wait for standards change or get help

02/18/2019

by: Roy Edroso

A new AMA survey shows that prior authorization remains both an administrative and a clinical problem for practices — but vendors can help, and process improvements may relieve the issue a bit in the near future.

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